Limb salvage in extensive diabetic foot ulceration: an extended study using a herbal supplement
Hong Kong Medical Journal
ORIGINAL ARTICLE: OBJECTIVE. To further study the clinical value of a herbal supplement in the treatment of chronic foot ulcers in diabetic patients. DESIGN. Double-blind randomised, placebo-control trial. Clinical measures included standard antidiabetic treatment, daily wound care including antiseptic bath, debridement, toe removal for gangrene when necessary, and the daily consumption of a herbal drink or placebo. The primary outcome was limb salvage. Secondary outcomes included: granulation maturation, local temperature and circulatory changes, tumour necrosis factor-alpha levels, and adverse events. Limb salvage was achieved in 85% of the patients. Among the early failures, three each came from the treatment and placebo groups. After shifting to herbal treatment (without unblinding of the original treatment), all were rescued in those initially assigned to herbal concoction (6 out of 6) while only 50% (6 out of 12) were rescued from among those initially assigned to placebo. The speed of granulation maturation, and decline in tumour necrosis factor- alpha levels indicating control of inflammation, were also more favourable with the herbal group. No serious adverse events were observed. It appears that herbal adjuvant therapy was effective in helping the healing of chronic diabetic ulcers.
Management of acute Achilles tendon ruptures in the United Kingdom
Journal of Orthopaedic Surgery
ORIGINAL ARTICLE:A questionnaire with 4 different Achilles tendon rupture scenarios affecting patients of different ages and activity levels was sent to orthopaedic consultants specialised in sports trauma, foot and ankle surgery. Their treatment methods including surgical techniques, immobilisation and rehabilitation regimens were surveyed. The response rate was 22% (51/231). Among the 51 respondents, 25 had managed less than 6 such patients in the preceding year. 26 (51%) used clinical examination (e.g. calf squeeze test) to make the diagnosis, 16 (31%) used ultrasonography, and 4 (8%) used magnetic resonance imaging. Surgical management was preferred for younger and more functionally demanding individuals. Open repairs were used more often than percutaneous repairs (72 vs 19%). Across the 4 scenarios, the mean time to return to full activity was 17 (range, 12- 32) weeks for conservative to 19 (range, 10-40) weeks for surgical management.. Variation in opinion among respondents was wide. Randomised controlled trials are needed to assess optimal treatment.
Outpatient percutaneous flexor tenotomies for management of diabetic claw toe deformities with ulcers: a preliminary report
Canadian Journal of Surgery
ORIGINAL ARTICLE: The objective of this study was to retrospectively review the outcomes of percutaneous flexor tenotomies of diabetic claw toes with ulcers or pending ulcers. We undertook a retrospective chart review between January 1999 and June 2005 to identify those patients who had undergone a percutaneous flexor tenotomy for diabetic claw toe deformities. We identified 34 toes in 14 patients. Of these, 24 toes had ulcerations at the terminal aspect and 3 had radiographic evidence of osteomyelitis of the terminal phalange. All patients had palpable pulses and good capillary refill. A percutaneous flexor tenotomy was performed on all toes in an outpatient clinic; patients with a rigid flexor contracture at the proximal interphalangeal joint underwent an osteoclaysis to correct a portion of the deformity. The average follow-up was 13 months. All patients with ulcers healed and there were no significant complications. Those without osteomyelitis healed within an average of 3 weeks and those with osteomyelitis healed within an average of 8 weeks. The journal concluded that percutaneous flexor tenotomy with osteoclasis of the proximal interphalangeal joint performed in an outpatient clinic is a safe and effective method to off-load the tip of the toe so that that ulcer healing can occur. The presence of osteomyelitis is not a contraindication for this technique; however, an increased healing time can be expected.
The Arizona Podiatric Medicine Program Graduates its First Class in 2008
The Foot & Ankle Journal 
Correspondence: The Arizona Podiatric Medicine Program began accepting applicants for Podiatric education in 2004. This year will mark the first graduating class. The Podiatry school is located in Glendale, Arizona and is in association with the Medical school at Midwestern University. We contacted Dr. Paul J. Kim, who is Assistant Professor at the Podiatric Medicine Program at Midwestern University.
New Techniques Update: Coblation for the Treatment of Plantar Fasciosis
The Foot & Ankle Journal
Correspondence: On November 6, 2006, The Foot Blog reported on a NIH study head by Dr. Scott Weil , DPM on the treatment of plantar fasciosis using the Arthrocare Topaz Microdebrider. The report was entitled “Coblation Technique in the Treatment of Plantar Fasciosis”. This is a phase IV study beginning in August 2005 and ending in February 2007. The study is funded and sponsored by the ArthroCare Corporation. They are the makers of the ArthroCare TOPAZ MicroDebrider. It’s been a year since the completion of this study, so we contacted Dr. Weil recently on the results of the study:
Podiatry Today ENews
Podiatry Today-February 2008
ACFAS Changes Dual APMA Membership Policy
By Brian McCurdy, Senior Editor
In a change to a longstanding policy, the American College of Foot and Ankle Surgeons (ACFAS) recently lifted a requirement that renewing college members must maintain a membership in the American Podiatric Medical Association (APMA). The policy change only affects renewing members as new ACFAS members still must belong to APMA when they join the college.
How To Handle Difficult Post-Op Patients
By John V. Guiliana, DPM, MS
Difficult patients can pose an array of challenges. Depending upon the patient, you may have to address his or her anger, non-compliance to a postoperative regimen or his or her unrealistic expectations in regard to surgical outcomes. Accordingly, this author discusses keys to empathizing with the patient as well as proactive pointers about documentation, appropriate referrals and essential steps for avoiding malpractice land mines.
Is External Fixation Overutilized In Managing Charcot In The Diabetic Foot?
By George Liu, DPM, FACFAS
Historically, surgeons have utilized circular and monolateral external fixation for the management of complicated high-energy orthopedic trauma and reconstruction of congenital or posttraumatic deformities through the Ilizarov and deBastiani principles of callotasis and distraction osteogenesis.
When A Pediatric Patient Has Severe Itching On Her Heels
Guest Clinical Editor: William Fishco, DPM, FACFAS
A 4-year-old girl presented to the office with her mother, who was concerned about a skin problem affecting her heels. According to her mother, the patient’s symptoms were present for six months or more. The child’s symptoms included a severe itch that caused constant scratching, pain and cracking of the skin leading to bleeding.
The Foot Blog News
Issue 33
February 2008:
- Alternative Treatment for Warts
- Get Well Soon – Without Antibiotics, UK
- Using Flower Power To Fight Foot Woes
- New Spring Runners More Susceptible To Injury
- Equine Podiatry?
- U.S. blacks get sepsis at twice the rate of whites
- Sugary drinks raise risk of gout in men
- Blue Cross And Blue Shield Companies To Host Second Annual National Walk Lunch Day On April 30, 2008
- Billy Gillispie’s Shoes Being Auctioned
Original article:A case describing the use of the Orthosphere® Zirconia Ceramic Implant (Wright Medical Technology, Arlington, TN) is presented. The tarso-metatarsal joints in the foot are common sites for degenerative arthritis and pain secondary to trauma and biomechanical abnormalities. Often, conservative treatment is unsuccessful in relieving symptoms, and surgical intervention is required. The clinical presentation and surgical indications for use of the implant is described. A case is presented describing the indications and surgical technique. This implant has practical and promising implications for use in tarsal-metatarsal joint arthritis. 
ORIGINAL ARTICLE:A case report describes an acute allergic contact dermatitis (ACD) to Mastisol following foot surgery. A patch test was used to determine whether the patient was allergic to the DuraPrep skin prep, Steri-Strips or Mastisol skin adhesive. Reaction to all patch sites with Mastisol was observed. The contact allergy resolved within 3 to 5 days after starting oral Benadryl, Medrol and topical saline compresses. Initial presentation, patch testing and treatments are presented. 
Original article: Pain and emesis are the two major complaints after day case surgery. Local anaesthesia has become an important part of optimizing intra and post-operative pain treatment, but is sometimes not entirely sufficient. The aim of the present study was to study the effect of adding an ankle block to a multi-modal analgesic approach on the first 24-hour-need for rescue analgesia in patients undergoing elective Hallux Valgus surgery. Type of study: Prospective, randomized patient-blind study comparing ankle block with levo-bupivacaine, lidocaine and Saline placebo control. Ninety patients were studied comparing ankle block (15 cc) using levo-bupivacaine 2.5 mg/ml, lidocaine 10 mg/ml or placebo (saline) on day-case elective Hallux Valgus surgery, supported by general anaesthesia in all cases. Primary study endpoint was number of patientas requiring oral analgesics during the first 24 post-operative hours. 
Original article: Closure of large wounds has been a challenge in podiatric surgery, especially after large defects created by ulcer debridement, metatarsal resection and amputation. The DermaClose RC tissue expander allows for closure of large defects without the need for traditional complex skin closure, tissue grafting or creation of skin and tissue flaps. Skin anchors made of surgical steel clips are used with a tension controller to allow for gentle skin stretching on the subcutaneous planes of the wound or defect. It also has special application in the closure of chronic wounds. Two case reports are presented to describe this technique. 
Original article: Between August 2003 and June 2005, 20 men aged 19 to 35 (mean, 23) years with chronic lateral instability affecting 21 ankles, underwent the modified Brostrom-Evans-Gould technique by a single surgeon. The mean follow-up period was 12 (range, 6-20) months. Patients were assessed preoperatively and postoperatively using the Kaikkonen Ankle Scoring Scale. RESULTS. Preoperatively, all patients had poor scores (<50). Postoperatively, 17 (81%) of the ankles attained excellent scores (85-100) and 4 (19%) attained good scores (70-84). 
